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Stroke survivors urged to keep moving

Most stroke survivors are doing little or no physical activity and spend most of their time sitting or lying down, despite evidence that being active can reduce the risk of having another stroke or heart attack, according to new research.

After suffering a stroke, many people spend around 80 per cent of their time sedentary despite evidence that even small and gradual doses of physical activity can help prevent subsequent strokes, the study found.

The research, by neurological physiotherapist Natalie Fini, was funded by the Heart Foundation and conducted at Alfred Health and La Trobe University.

Ms Fini’s report How Physically Active Are People Following Stroke? is published in this month’s edition of the academic journal Physical Therapy. She found that more than 78 per cent of stroke survivors’ time was spent being sedentary.

She said the many stroke survivors she meets in her clinical physiotherapy work had inspired her interest in the topic.

“After a stroke, there are limitations on how people can move. Many stroke survivors struggle to maintain their previous level of activity and a number of them weren’t very active to start with,” she said.

“Following a stroke, people can be scared or anxious about exercise in case it triggers another stroke, but in fact the opposite can be true. I’m really keen to explore how we, as physiotherapists, can help support them to either stay or become more active following a stroke, as this will improve their health long-term.”

Her review included 103 research papers involving more than 5000 participants with stroke aged 21 to 96 years.

Activity monitors had been used in about two thirds of the research papers. They showed that people who had had a stroke took on average 5535 steps per day in the period from two weeks to six months after a stroke, and 4078 steps in the chronic phase (six months onwards). This was less than half the activity of healthy matched individuals who took an average of 8338 steps per day.

Ms Fini said the American Stroke and Heart Association recommends that people with stroke perform aerobic activity for 20 to 60 minutes on three to five days per week, as well as strength, neuromuscular and flexibility exercises two to three days per week, to reduce their risk of future stroke and cardiovascular disease.

But, she says, “It is doubtful that stroke survivors meet the guidelines, which could increase their risk of further strokes.”

Ms Fini’s next step will be to complete the analysis of a longitudinal study that tracked stroke survivors from 2013 to 2017 to monitor physical activity, cholesterol, blood pressure and mobility.

“Based on this evidence, we would like to develop effective interventions and activity targets for clinical physiotherapists working with stroke patients during all periods of recovery.

“I want to give people long-term strategies to help them help themselves by making exercise and physical activity a part of their life, despite their challenges.

“Walking is a great form of physical activity, but people with stroke can also increase their physical activity simply by breaking up long periods of sitting, or increasing the amount of light jobs they do around the house – this ‘light’ physical activity also has health benefits.”

Heart Foundation Chief Medical Advisor Professor Garry Jennings said the Heart Foundation, the largest non-government funder of heart disease research in Australia, is proud to invest in research to help all Australians have better cardiovascular health.

“The Heart Foundation has invested more than $550 million in today's value in cardiovascular research since 1962, including $16.9 million in 2017,” he said.

How Physically Active Are People Following Stroke? Systematic Review and Quantitative Synthesis, Physical Therapy, Oxford University Press (July 2017)